Depression and suicidality among adolescents living with human immunodeficiency virus in Lagos, Nigeria

Prevalence of mental disorders among young people living with HIV: a systematic review and meta-analysis

Objective

This meta-analysis aims to evaluate the global prevalence of mental disorders among young people living with HIV.

Methods

A comprehensive search was conducted of the PubMed, Embase, and Cochrane Library databases for articles relevant to the study, published between January 2013 and June 2023. To identify sources of heterogeneity and compare prevalence estimates among various groups, subgroup analyses were conducted. Study heterogeneity was assessed using Cochran's Q and the I 2 tests. The robustness of the findings was ascertained through sensitivity analyses, while publication bias was evaluated with funnel plots and Egger's test.

Results

Sixty studies were included in this meta-analysis. It revealed that approximately one-quarter of YLWH experience depression, with a prevalence of 24.6% (95% CI: 21.1-28.2%). The prevalence of anxiety was found to be 17.0% (95% CI: 11.4-22.6%). Regarding suicidality, the prevalence of suicidal ideation and lifetime suicidal ideation in YLWH was 16.8% (95% CI: 11.3-22.4%) and 29.7% (95% CI: 23.7-35.7%), respectively. Additionally, the prevalence rates for suicidal attempts and lifetime suicidal attempts were 9.7% (95% CI: 4.0-15.4%) and 12.9% (95% CI: 2.8-23.1%), respectively. The prevalence of Post-Traumatic Stress Disorder and Attention Deficit Hyperactivity Disorder was identified as 10.5% (95% CI: 5.8-15.2%) and 5.0% (95% CI: 3.1-7.0%), respectively.

Conclusion

The findings indicate a heightened risk of mental disorders among YLWH, underscoring the necessity for targeted intervention strategies to mitigate their suffering and potentially diminish the adverse impacts.

Systematic Review Registration

PROSPERO, identifier CRD42023470050, https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023470050.

Teenage Blues: Predictors of depression among adolescents in Nigeria

BACKGROUND

Depressive disorders, with a prevalence of 15-21%, are among the most common disorders in children and adolescents, and increases the risk of suicide, the second leading cause of death in children aged 10 to 19.

AIM

To determine the prevalence and correlates of depressive disorders among senior students attending secondary schools in Abeokuta.

METHOD

The study was conducted in five schools randomly selected from a representative sample and was carried out in 2 phases. In the first phase, students were selected via systematic random sampling and given consent forms and GHQ-12 to administer to the parents. In the second phase, students who returned a signed informed consent form and filled out GHQ-12 were interviewed using MINI-KID, Rosenberg's Self-Esteem Scale, Family-APGAR, and sociodemographic questionnaire. Multivariate regression analyses were conducted with p-value <0.05 as level of significance.

RESULTS

The mean age was 15.3 years (SD = 1.27); 48.8% were male. The twelve-month prevalence of major depression was 11.3% and dysthymia was 1.4%. In the final regression analysis, female gender [OR = 4.3, p = 0.046], the experience of bullying [OR = 7.96, p = 0.004], difficulty getting along with friends, [OR = 7.5, p = 0.004], history of sexual abuse [OR = 8.1, p = 0.01], and perceived family dysfunction [OR = 4.9, p = 0,023] were found to be independent predictors of depressive disorders.

CONCLUSION

Depressive syndromes are a significant health burden in adolescents. Being female, being bullied, having a history of sexual abuse, and family dysfunctionality are risk factors associated with depression among these population.

M. SP, Ku HC, Wu YL, Ko NY. Global overview of suicidal behavior and associated risk factors among people living with human immunodeficiency virus: A scoping review

Death by suicide is a major public health problem. People living with human immunodeficiency virus (PLHIV) have higher risk of suicidal behavior than the general population. The aim of this review is to summarize suicidal behavior, associated risk factors, and risk populations among PLHIV. Research studies in six databases from January 1, 1988, to July 8, 2021, were searched using keywords that included "HIV," "suicide," and "risk factors." The study design, suicide measurement techniques, risk factors, and study findings were extracted. A total of 193 studies were included. We found that the Americas, Europe, and Asia have the highest rates of suicidal behavior. Suicide risk factors include demographic factors, mental illness, and physiological, psychological, and social support. Depression is the most common risk factor for PLHIV, with suicidal ideation and attempt risk. Drug overdosage is the main cause of suicide death. In conclusion, the current study found that PLHIV had experienced a high level of suicidal status. This review provides an overview of suicidal behavior and its risk factors in PLHIV with the goal of better managing these factors and thus preventing death due to suicide.

Mental health and ART adherence among adolescents living with HIV in Mozambique

Little is known about the mental health needs of adolescents living with HIV (ALWH) in Mozambique, including the potential relationship between mental health challenges and poor antiretroviral treatment (ART) adherence. We examined mental health problems (anxiety, depression, post-traumatic stress disorder [PTSD] symptoms and impairment) and their association with self-reported ART adherence among ALWH ages 15-19 in Nampula, Mozambique. The associations between each mental health problem area and sub-optimal adherence were estimated using logistic regression, controlling for age, education, and social support, with interaction by gender. Males had significantly higher anxiety (5.6 vs 4.3, p = 0.01), depression (5.8 vs 4.1, p = 0.005), and PTSD (13.3 vs 9.8, p = 0.02) symptoms and impairment (1.8 vs 0.56, p<0.0001) scores than females. Proportion reporting sub-optimal adherence (65%) did not differ by gender. Higher anxiety, depression, and PTSD symptom and impairment scores were significantly associated with higher odds of sub-optimal ART adherence in males but not females. Among Mozambican ALWH, mental health problems were prevalent and two-thirds had ART adherence less than 90%. Worse mental health was associated with increased odds of sub-optimal ART adherence in males but not females. Interventions are needed to address mental health problems and improve ART adherence in Mozambican ALWH, particularly among males.

Academic stress and suicidal ideation: moderating roles of coping style and resilience

BACKGROUND

As a global phenomenon, suicide has generated a lot of concern. Scholars from various fields have conducted extensive research on the prevalence, causes, factors, and/or management or possible solutions to suicidal ideation. Despite the research efforts, suicidal cases worldwide still yell for more empirical attention. No doubt that some of the extant literature have specifically evidenced the causal links and factors in suicidal ideation. Yet, none had focused on the moderating roles of coping and resilience in an academic population. We therefore, examined the moderating roles of coping and resilience in the relationship between academic stress and suicidal ideation.

METHOD

We used a cross-sectional design to sample 505 participants (329 males and 176 females) from three southern Nigerian universities. Participants who willingly indicated their participatory consent were administered a paper self-report questionnaire containing the Lakaev Academic Stress Response Scale (LASRS), Scale for Suicidal Ideation (SSI), Brief COPE (B-COPE), and Resilience Scale (RS-14). Hierarchical regression analysis was used to test the hypotheses of the study. Academic stress (r = 0.17; p.001) was found to be positively associated with suicidal ideation, whereas resilience (r = -.22; p.001) was found to be negatively associated with suicidal ideation. Suicidal ideation had no significant correlation with adaptive coping style, but it did have a significant correlation with maladaptive coping (r = .15; p.001). The regression-based PROCESS macro showed that academic stress was a significant predictor of coping [ΔR² = .03, F (1, 502) = 16.18, p = .01]. Academic stress was positively associated with suicidal ideation at low or moderate levels of adaptive coping styles. At high levels of adaptive coping styles, the association between academic stress and suicidal ideation was not significant. However, resilience negatively predicted suicidal ideation [R = .29, (R² = .08), F(1, 499) = 19.94, p = .00] with academic stress showing a positive association with suicidal ideation at low and moderate levels of resilience, but for those with high resilience, academic stress was not associated with suicidal ideation. In sum, suicidal ideation is heightened by increased academic stress, with greater resilience ameliorating the tendency of academic stress resulting in suicidal ideation. Also, adopting maladaptive ways of coping promotes suicidal ideation among students, with resilience and adaptive coping strategies moderating the relationship between academic stress and suicidal ideation. It is therefore recommended that educational administrators, policy makers, lecturers, teachers, and tutors incorporate courses, teachings, and sessions that foster as well as inculcate resilience and efficient coping skills in pupils and students.

Depression and suicidal behavior among adolescents living with HIV in Botswana: a cross-sectional study

BACKGROUND

Depression and suicidal behavior are the main causes of disability and morbidity, especially in adolescents living with HIV (ALWHIV). Data regarding these are lacking in Botswana, a country with a predominantly youthful population and ranked among the top four in the world most affected by HIV. Therefore, the present study aimed to estimate the prevalence of depression and suicidal behavior and explore their associated factors in Botswana ALWHIV.

METHODS

Responses were obtained from 622 ALWHIV using the DSM-5 and the Mini-International Neuropsychiatric Interview for Children and Adolescents.

RESULTS

The mean age (SD) of the participants was 17.7 (1.60) years and more males (54.3%) participated than females. Depression and suicidal behavior rates among adolescents were 23% and 18.9%, respectively. Female participants were more likely to be depressed (AOR = 1.96; 95% CI 1.11-3.45) and have suicidal behaviour (AOR = 6.60; 95% CI 3.19-13.7). Loss of mother (AOR = 2.87; 95% CI 1.08-7.62) and viral load of 400 copies and above (AOR = 5.01; 95% CI 2.86-8.78) were associated with depression. Alcohol use disorder (AOR = 3.82; 95% CI 1.83-7.96) and negative feelings about status (AOR = 8.79; 95% CI 4.62-16.7) were associated with suicidal behavior. Good support (AOR = 0.42; 95% CI 0.23-0.76) and increased frequency of religious activities were protective (AOR = 0.33; 95% CI 0.14-0.79) against depression and suicidal behaviour, respectively.

CONCLUSION

Therefore, routine psychologic screening, which includes identifying psychological stressors and maladaptive coping, family and caregiver support services, and psychosocial support platforms, should be integrated into the management package for ALWHIV in Botswana.

Prevalence and factors associated with common mental disorders in young people living with HIV in sub-Saharan Africa: a systematic review

INTRODUCTION

Common mental disorders (CMDs) particularly depression and anxiety, are highly comorbid with HIV also in young people living with HIV (YLWH). In sub-Saharan Africa (SSA) where most YLWH reside, there are limited summary data on CMDs among these youths, yet there are previous systematic reviews summarizing data on CMDs among adults living with HIV. We conducted a systematic literature review on the prevalence and correlates of CMDs among YLWH, aged 10 to 24 years, from SSA.

METHODS

We searched African Index Medicus, African Journals Online and five other electronic databases (from database inception up to 31 December 2020) for relevant studies published in English. The key search terms applied were as follows: "Depression OR Anxiety", "Young people", "HIV infections" and "sub-Saharan Africa".

RESULTS AND DISCUSSION

Out of 3989 articles, 31 studies were included in the review. The prevalence of CMDs in YLWH widely varied ranging between 16.0% and 40.8% for major depression, 4.4% and 52.6% for depressive symptoms and 2.2% and 25.0% for anxiety symptoms. Anxiety disorder was estimated at 45.6%. Four of the five included studies with a comparison group of HIV-negative young people reported significantly higher prevalence estimates of depressive disorders among YLWH. Several sociodemographic, psychosocial and HIV-related correlates of CMDs were reported but most lacked consensus across studies. Nevertheless, female sex, older age, fewer schooling years, HIV-positive status, bullying, sexual abuse, HIV-related stigma, social support and poor antiretroviral therapy adherence were frequently reported (in ≥2 studies) as significant correlates of depressive symptoms among YLWH. Higher social support was the only frequent significant correlate of anxiety symptoms.

CONCLUSIONS

The burden of CMDs among YLWH from SSA is substantial and appears to be significantly higher when compared with HIV-negative peers, particularly for depressive disorders. However, more comparative research is needed. Importantly, screening for CMDs at the youth HIV-clinics should be prioritized especially for YLWH at high risk of CMDs, to facilitate early management or referral for treatment. Furthermore, youth-friendly psychological interventions addressing CMDs in YLWH should urgently be piloted in SSA, incorporating contextual components that may directly or indirectly reduce symptoms of CMDs among YLWH, such as social support.

Childhood trauma, major depressive disorder, suicidality, and the modifying role of social support among adolescents living with HIV in rural Uganda

BACKGROUND

Childhood trauma is associated with mental health problems among adolescents living with HIV (ALHIV) in sub-Saharan Africa, but little is known about potential moderating factors.

METHODS

We enrolled 224 ALHIV aged 13-17 years and collected information on childhood trauma, major depressive disorder, and suicidality. We used modified multivariable Poisson regression to estimate the association between the mental health outcome variables and childhood trauma, and to assess for effect modification by social support.

RESULTS

Major depressive disorder had a statistically significant association with emotional abuse (adjusted relative risk [ARR] 2.57; 95% CI 1.31-5.04; P=0.006) and physical abuse (ARR 2.16; 95% CI 1.19-3.89; P=0.01). The estimated association between any abuse and major depressive disorder was statistically significant among those with a low level of social support (ARR 4.30; 95% CI 1.64-11.25; P=0.003) but not among those with a high level of social support (ARR 1.30; 95% CI 0.57-2.98; P=0.52). Suicidality also had a statistically significant association with emotional abuse (ARR 2.03; 95% CI 1.05-3.920; P=0.03) and physical abuse (ARR 3.17; 95% CI 1.60-6.25.; P=0.001), but no differences by social support were noted.

LIMITATIONS

Corporal punishment is used widely in schools and homes as a form of discipline in Uganda; this cultural practice could have biased reporting about physical abuse.

CONCLUSIONS

Childhood trauma is associated with poor mental health among ALHIV, but its effects may be moderated by social support. More research is needed to develop social support interventions for ALHIV with adverse childhood experiences for improved mental health outcomes.

The Prevalence of Suicidal Ideation and Attempt Among Young People with HIV/AIDS: a Systematic Review and Meta-Analysis

Studies have suggested that suicidal ideation and attempt are highly prevalent among young people with HIV/AIDS and have been linked with increased risk of complete suicide. However, thus far, there are no worldwide systematic reviews and meta-analysis of the prevalence of suicidal ideation and attempt among young people with HIV/AIDS. A systematic search of PubMed, Scopus, and Web was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Prevalence rates from individual studies were pooled by using a random-effect meta-analysis. The quality of included studies was assessed by the Joanna Briggs Institute's quality assessment checklist. We used the Cochran's Q and the I² tests to measure heterogeneity across the studies. In total, 14 studies involving 4842 young people with HIV/AIDS were included in this meta-analysis. Our random effect meta-analysis indicated that roughly a quarter of young people with HIV/AIDS had lifetime suicidal ideations [24.38% (95% CI; 18.49-31.44)], and more than one in ten had current [10.33% (95% CI; 6.13-16.88)], and 6 month [13.03% (95% CI; 4.71-31.24)] suicidal ideations. Likewise, a significant proportion of young people with HIV/AIDS had current [3.75% (95% CI; 2.30-6.06)], 6 month [15.33% (95% CI; 10.00-22.78)], and lifetime [13.05% (95% CI; 7.55-21.61)] suicidal attempts. The pooled prevalence estimate of both suicidal ideation and attempts varied according to the sample size of the participants. This study found that a considerable proportion of young people with HIV/AIDS had suicidal ideation and attempt, suggesting the urgent needs of intervention strategies to relieve the suffering and possibly prevent death due to suicide.